Charges

The charges we make are: for the examination $245 (code 99204; extended retinal examination with drawing $55 (code 92225) for each eye; pre-operative floater photograph $65 (code 92250) for each treated eye; and for the procedure of laser treatment of eye floaters $1,485 per eye (code 67299-58). This totals $1,905 for the first eye and $1,550 if the second eye is done. You may call our office at (703) 536-2400 to ask about charges.

Payment

We submit the fee for the examination, the extended retinal examination, and the photographs to your insurance company if we participate with them. We request payment at the time of service for the laser fee even though you may have insurance.  We do this because many insurance companies are not familiar with this procedure;  they do not know the judgment, expertise, skill, and especially the time needed for a successful result;and they do not know that a special laser is required that is not available to most ophthalmologists.  Also they do not know that the our one laser fee per eye covers up to four laser procedures if required.  Insurance companies have classified the procedure as experimental, investigational, and not medically necessary.  Importantly, this is a non-standard procedure, meaning there is no listed procedure code that describes it. Thus, the procedure code used is 67299-58 (“unlisted posterior segment ophthalmology procedure”). Because reimbursement is so variable from insurance companies (most paying nothing, and others paying poorly), we collect payment at the time of the procedure. At our office you will be asked to sign a form saying that the patient is responsible for the full laser fee payment.

The laser fee covers up to four treatments per eye during a three month period. In the great majority of patients we need only two treatments per eye during the initial trip here, and then the case is considered finished. But if the patient has very large floaters or multiple floaters (we discuss this with the patient before starting treatment), three treatments may be given while here. If a patient needs to come back for a third or fourth treatment within three months, that is done without any additional laser fee; however, we charge at that time $200 for the examination ($145 for the regular examination and $55 for the extended retinal examination with drawing (code 92225).  After three months the fees are $200 for the examination plus $650 for additional laser treatment if done.

We participate with the following insurance companies for the examination, the extended retinal examination, and the photographs: Cigna (PPO), GEHA, and United Healthcare Group. (United Healthcare Group's PPO's are One Net [Alliance], Choice, Choice Plus, and Mamsi Life. Their HMO's are Select, MD IPA, and Optimum Choice. Referrals are required for MD IPA and Optimum Choice.) We participate with Anthem (Blue Cross Blue Shield of Virginia), First Health Network, Coventry, Mutual of Omaha (AFSPS-American Foreign Service Protective Agency), Aetna (not Aetna/Pioneer), Aetna HMO, Coventry, Mail Handlers, Medicare/Unicare combo, PHCS (Private Health Care System of the Nation Capitol Area), Multi-Plan, Blue Cross-Blue Shield of D.C., Great West, Choice Care Network, Care First BCBS PPO, and Care First of MD.

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John Karickhoff, M.D. • 313 Park Avenue • Falls Church, VA 22046

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